I'd like to talk about randomized single-blind comparative study of methadone plus petylene combination and methadone-derived pharacoscopy. In NHCLC, searching driver genes from tumor samples is important. Pharacoscopy is one of the most common methods to collect the samples, but it is often uncomfortable for patients. British Thoracic Society guidelines state that combination opioid and methadone sedation should be considered in patients to improve bronchoscopic tolerance. When opioids are used, short-acting agents should be used to minimize post-procedural sedation. But there are no recommended drugs for use. Petylene is a synthetic narcotic analgesic with a plasma half-life of 3 to 4 hours. In Japan, petylene is commonly used as well as fentanyl. The aim of this study was to demonstrate the effectiveness and safety of administration of the combination of methadone and petylene during bronchoscopy. The primary end point is the patient's acceptance of re-examination assessed by visual-analog scale. Secondary end points are patient's subjective symptoms, thoughts of drug, and safety. We conducted a randomized swing-blind comparative study. Patients aged between 20 and 79 years undergoing bronchoscopy for biopsy of lung tumors or medicinal tumors. 2mg methadone and 17.5mg petylene were given the combination group, and 2mg methadone and placebo were given methadone group interversely before the start of bronchoscopy. Method for evaluating sedation was used by modified observer's assessment of alertness sedation, MOA-SCORE. This slide about consort from diagram. We analyzed 47 patients in the combination group and 49 patients in the methadone group. Table 1 shows patient characteristics and pre-operative vital signs. There are no significant differences between the two groups except for height. Table 2 shows the type of bronchoscopic procedures. Between the two groups, there are no significant differences. Table 3 shows visual-analog scale of patient's subjective pain before and during bronchoscopy. BASC score for question 5 was significantly lower in the combination group. There was no significant difference regarding the type of primary outcome. BASC score for question 10. Table 4 shows objective indicators and vital signs. The examination time was significantly shorter and the additional number of methadone administration was significantly lower in the combination group. Adverse events were significantly more frequent in the methadone group. There was no significant difference regarding the primary outcome. The combination with petylene resulted in a reverse sedation, a significant reduction in the number of additional methadone and in examination time. There was significantly fewer intra- and post-test adverse events in the petylene combination group. There is a report that fentanyl-methadone combination can result in better patient and operator satisfaction when compared with methadone alone. The primary endpoint of our research may not have been appropriate because it is expected the patient will decide to undergo bronchoscopy if necessary. The MOA score used in the assessment of depth of sedation is assessed by the doctor and may be subjectively biased. Methods for evaluating sedation also need to be considered. The last slide about conclusion. Thank you for listening.

randomized study

methadone

petylene

bronchoscopy

patient safety